Contract Year (CY) 2020 Medicare Advantage and Part D Flexibility Proposed Rule (CMS-4185-P) On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit program (Part D) by promoting flexibility and innovation so that MA and […]
CMS Proposes to Modernize Medicare Advantage, Expand Telehealth Access for Patients Proposed rule would strengthen the popular system for private health insurance plans to provide Medicare coverage, increase plan flexibility to offer telehealth benefits, and improve coordination for dual-eligible beneficiaries In a proposed rule issued today, the Centers for Medicare & Medicaid Services (CMS) took […]
In Depth The Centers for Medicare & Medicaid Services (CMS) released a Notice of Proposed Rulemaking on Friday, October 26, 2018 (the Proposed Rule) addressing expanded telehealth coverage in Medicare Advantage (MA), extrapolation of Risk Adjustment Data Validation (RADV) audit results, and updates to the MA and Part D Quality Star Ratings program, among othertopics. […]
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CMS finalizes calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy Suppliers On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1689-F] setting out finalized Calendar Year (CY) 2019 Medicare payment updates, finalized quality reporting changes for home health agencies (HHAs), […]
The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]
Please see below for CMS Final Rule Update* CMS has proposed three new codes for RPM services, retitled “Chronic Care Remote Physiologic Monitoring,” which do a far better job reflecting how providers can more effectively and efficiently use RPM technology to monitor and manage patient care needs, including chronic care management. If finalized, these three […]
Oct 17, 2018 Tanya Albert Henry Contributing Writer Reflecting the reality that physicians and their staff spend an increasing amount of time engaging with technology to enhance and improve patient care, the 2019 Current Procedural Terminology (CPT®) code set that takes effect Jan. 1 provides health professionals the codes they need to get paid for […]
The AMA’s new CPT codes streamline virtual care visits, simplifying and incentivizing telehealth services for mainstream clinical practices. Recently, the American Medical Association revealed the 2019 Current Procedural Terminology (CPT) code set. These codes make it possible for physicians and other healthcare providers to bill insurers for services provided to patients. With this year’s changes […]
Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. Select anywhere […]
ACO stakeholders ask CMS to keep upside-only risk model, while 29 others from Next Gen ACO Coalition want to make risk more predictable. Susan Morse, Senior Editor Two interesting developments happened on Thursday that could impact the future of Accountable Care Organizations and the amount of risk they manage. First, 29 of the 51 Next […]
Remote patient monitoring programs offer multiple clinical and financial benefits, including reducing hospital admissions among patients, according to a new KLAS Research report. KLAS Research partnered with the American Telemedicine Association to examine success factors for remote patient monitoring programs at different healthcare organizations, including hospitals, payers and home health agencies. As part of the […]
By Kaitlyn Mattson | October 7, 2018 The home health industry has won another victory in Washington, D.C., in its battle against certain parts of the Patient-Driven Groupings Model (PDGM) and shift toward a more pre-acute care identity. Sens. Susan Collins (R-Maine), Bill Nelson (D-Fla.) and Debbie Stabenow (D-Mich.) introduced the Home Health Payment Innovation […]
Technological advances continue to expand the healthcare delivery marketplace. Through technology, more and more providers are trying to cash in on telehealth. As with any other business, the healthcare industry is driven by profitability. In healthcare, profitability is generally driven by reimbursements from government payers such as Medicare and Medicaid, private insurers such as Blue […]
By Robert Holly | September 17, 2018 Federal policymakers are again taking aim at costly administrative and paperwork burdens for the home health and hospice industries in order to help providers save tens of millions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) on Monday announced its latest proposed rule focused on […]